title: Cytomegalovirus infection in non-transplant patients with hematologic neoplasms: a case series.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is uncommon in hematology patients. The clinical pictures and outcomes of this virus are not entirely clear.
  
  
  METHODS
  Consecutive cases of CMV infection (17 patients with 20 episodes) were compiled for study over a six year period.
  
  
  RESULTS
  CMV infection occurred in patients of various ages and with a number of underlying hematological diseases, including non-Hodgkin's lymphoma, multiple myeloma (MM), acute myeloid leukemia (AML) and myeloproliferative neoplasm, No single laboratory assay was sensitive enough to serve as a screening test in the diagnosis of CMV infection. A combination of laboratory assays, clinical features and radiographic findings were required for diagnosis. All patients with AML or MM had received various chemotherapies before CMV infection. All but one lymphoma patient had received steroids and rituximab treatment prior to CMV infection. CMV infection episodes were accompanied by various co-infections in 60% (12/20) of cases. Bacterial lobar pneumonia was the most common form of co-infection. We used ganciclovir as the sole antiviral treatment in most of the infection episodes (18/20). Anti-CMV immunoglobulin (cytotect) was also provided to one patient because of persistent fever and dyspnea. Treatment was successful in all but one of the cases, which occurred when ganciclovir was initiated after respiratory failure. This patient died of CMV pneumonia. The other patients had good initial responses to antiviral treatment, but their long-term outcome was poor. Only five patients survived after a short follow-up duration.
  
  
  CONCLUSIONS
  In an era of intensive immuno-chemotherapy, CMV infection may become a serious threat for hematology patients. Physicians dealing with hematological malignancies should be aware of CMV infection, especially for patients receiving rituximab and steroids.
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Hung
authors.initials: H
authors.lastname: Chang
authors.forename: Tzung-Chih
authors.initials: TC
authors.lastname: Tang
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Hung
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Lin
authors.forename: Ming-Chung
authors.initials: MC
authors.lastname: Kuo
authors.forename: Po-Nan
authors.initials: PN
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D002066:Busulfan / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents; D002066:Busulfan